Diabetic patients with autonomic cardiac neuropathy had significantly higher mean rest peak ejection rates (4.4 vs 3.4; p<0.05) and subclinical left ventricular diastolic dysfunction.
Observational (n=20)
Does autonomic cardiac neuropathy correlate with left ventricular dysfunction at rest and during hand-grip test in diabetic patients?
Diabetic patients with autonomic cardiac neuropathy exhibit subclinical left ventricular diastolic dysfunction and sympathetic overactivity at rest, with marked systolic impairment during hand-grip stress.
p-value: p=<0.05
Left ventricular function of 20 diabetic patients was investigated at rest and during hand-grip test using radionuclide ventriculography. The aim of the study was to discuss the correlation of cardiac function with autonomic cardiac neuropathy (ACN) in diabetic subjects. ACN was tested using heart rate response to valsalva maneuver, standing up, deep breathing; blood pressure response to standing up, sustained hand-grip, and additionally corrected QT (QTc) measurements. Plasma glucose regulation was screened with fructosamine levels. Ejection fraction (EF), peak ejection (PER) and filling rates (PFR), times to peak ejection (TPE) and filling (TPF), time to endsystole (TES), TES/T, TPE/T, TPF/T, 1/3 PER, 1/3 PFR, 1/3 EF, 1/3 FF (filling fraction) we calculated. Thirteen patients had ACN. Six patients (30%) had a low EF at rest. As a response to hand-grip, 14 patients (70%) showed a decrease in EF (9 ACN). PFR was low in 10 patients (50%) at rest and in 12 (60%) during hand-grip. The mean rest PER value of ACN+ patients (4.4 +/- 1.3) was significantly higher than that of controls (2.9 +/- 0.5) and patients without ACN (3.4 +/- 0.4; p < 0.05) as well as the mean 1/3 PER value (1.7 +/- 0.5 vs. 1.3 +/- 0.5; p < 0.05). Fourteen patients (70%) had a fall in PER 10 ACN) as a response to hand-grip. The mean TES/T value of patients with ACN (0.44 +/- 0.05) was significantly higher than of those without ACN (0.38 +/- 0.05; p < 0.05). In conclusion, diastolic dysfunction was detected frequently at rest. Systolic parameters were markedly impaired as a response to hand-grip in patients with ACN. Sympathetic overactivity was noted in ACN+ group at rest. Our results indicated that the patients with diabetes and ACN have subclinical left ventricular diastolic dysfunction and symphatic overactivity.
Erbaş et al. (2008) conducted an observational in Diabetes with or without autonomic cardiac neuropathy (n=20). Hand-grip test with radionuclide ventriculography vs. Diabetic patients without autonomic cardiac neuropathy and healthy controls was evaluated on Left ventricular function parameters including peak ejection rate (PER) and time to endsystole (TES/T) (p=<0.05). Diabetic patients with autonomic cardiac neuropathy had significantly higher mean rest peak ejection rates (4.4 vs 3.4; p<0.05) and subclinical left ventricular diastolic dysfunction.